Practice Management Blog

Okay, yes, I know, health care reform was passed. Way back in March 2010 the law (Patient Protection and Affordable Care Act) also now known as Obama care was passed. At that time many were worried, not unlike the early 90’s when health care was in a frenzy with “Hillary Care”. Of course the law was a mere 1900+ pages long, and it took months for even the experts to begin to grasp how this new legislation would be dramatically re-shaping our health economy. At that time, we can all admit that we really had no idea what was in store with health reform, but we were learning about some “new terms” such as ACO, Meaningful use and other words and phrases that seemed to provide more and more fear with physicians. At the same time, many hospitals started planting ideas about how prospective payments or bundling would be impacting physicians. Many feared that the day of the independent physician groups would soon be over, after all, the hospitals would need to “own all of the physicians” to make health reform really work.

Leaders of the health reform movement told us that the ACO model was coming. We also feared the change in regulation for decreasing the number of uninsured by way of increasing Medicaid patients. Many believed the only way to escape the fear would be to become employed by hospitals. Fast forward a few short months to the fall of 2010 when trade groups such as HFMA (Healthcare Financial Management Association) started to really provide us with some of the details about what health reform might mean. We learned that many of the key aspects of reform might actually help the physicians – for example, making the switch to electronic health records EHR or Electronic medical records would actually be subsidized by the government. We learned that soon physicians would be paid to provide some of the preventative health that we already provide. We also learned that there were suddenly varying opinions on what an a ACO would look like, particularly when it was clear that the regulations for ACO’s would be as complex as health reform and was the size of a medium large city yellow pages book. Back in the fall many were afraid, but groups that I’ve been working with in the last six months or so are seeing a changing tide.

Some of the really fundamentally components of health reform have been showing weakness. In fact, I believe that the direction of health reform continues to accelerate at an increasing pace in a negative direction. For example, it was one of the basic tenants of the reform was that it would provide coverage for all members of society – if you were an employer you would have to provide the coverage or face severe penalties. Interestingly enough, the Obama administration has been willing to sacrifice and has provided waivers (which by the way are not part of the statute) to employers. In fact, a recent article in the Wall Street Journal states that over 1,300 employers such as McDonalds have been granted such waivers. The article stated that we were “Waiving Obama Care Goodbye”. I frankly think it’s the tip of the iceberg.

If you read papers such as the Wall Street Journal you will notice more discussions about the very thing physicians were afraid of ACO’s. On June 13 one of the organizations that much of this alleged health reform was supposed to be patterned after, the famed Mayo Clinic, stated in the Star Tribune that they opposed key health reform provisions including the ACO’s. The article continued to not that the proposed regulations conflict with the way Mayo runs its Medicare operations. A recent opinion published, again in the wall street journal was entitled “The Accountable Care Fiasco”. In that article it states that “Even the models for health reform hate the HHS rules.

As we continue to ford through these changing tides of healthcare, we acknowledge that health care is broken, the complexities of health care are not improving, in fact they are becoming more complex.

If you would like to learn more about our opinions on health care, and how we can help you navigate give us a call 1-866-222-4488, we will be happy to work with you to educate you and your team.

Physicians today are struggling.They are concerned about “Obama Care”, declining reimbursement, and poor payer mix among other things.Actually, I would contend that they are concerned about what they don’t know.Much of the “reform” that has been touted has not really been articulated; in fact the ACO regulations were just recently published.It is human nature to be afraid of the unknown and today, from my perspective that is what physicians really fear the most.Physicians are contemplating selling their practices as never before with the fear of an ACO taking over all that they do.Before you sell consider the following options

1)Do you really “need” to sell your practice?Practices that have contemplated the sale question may not understand what their current compensation is compared to peers.That’s where a benchmark survey comes in.Do you know if your current practice is compensating you above your peers or lower.What does compensation if you are employed by a hospital look like?Did you know that there are benchmark compensation reports that show the variance between physicians employed by a hospital or those employed in private practice?

2) If you sell your practice what will change?Often physicians will be offered a lucrative contract to join the hospital’s medical group, but what happens in two years after being employed.As a consultant I have helped physicians negotiate the sale of their practice to a hospital, but I have also helped them transition back into a independent practice.Physicians are often surprised by the number of staff that they have loyally cared for over the years being adsorbed by the hospital, relocated to a central billing office or even dismissed from employment.Does the hospital have an “outreach program”, it’s likely they do, and it’s likely that they’ll want you to travel for them to help them “grow their market”.Be ready to put some miles on.This does not have to be a bad thing, finding complex, interesting cases can be very rewarding, but the time commitment can be significant, depending upon the market you’re working in and the market the hospital wants to grow.

3) How happy are other physicians that have sold their practices to the same hospital?Make sure that you do your own surveillance to identify what has been positive for other physicians who have made the transition to be employed by the hospital.Make sure that you talk with your colleagues in the same specialty, and get a good sample of physicians who have been employed for a year, two years or three years to get a good idea of the culture of being employed.

At Systems Consulting, we work with physicians to be objective, to evaluate their practice and help them to make decisions with objective data and benchmarks.Our team can help you to unravel to complexity of your practice and provide expert guidance.Call us today to learn more, we offer a free 30 minute telephone call to get you started.